Agenda item

Alison Lancaster and Kerri Booker, RDaSH, to present

Alison Lancaster and Kerri Booker, RDaSH, together with Kate Tuffnell, Rotherham Clinical Commissioning Group, presented the recommendations for the future RDaSH service based on the work that had been carried out in Phases 1 and 2.

 

The Clinical Commissioning Group and RDaSH were working closely with the Authority and health professionals to explore the potential for shared services such as a Rotherham Hub as an initial single point of contact and co-location of services.

 

A number of public engagement events had been held during 2015-16 to discuss the proposals as they had evolved and been informed by consultation and feedback.  This had culminated in the recommendations for the future Service set out in the attached report.

 

At the Select Commission meeting on 17^th December, 2015 (Minute No. 60), option 3, the needs-led community based approach, had been supported.  However, since then the model had developed further (Minute No. 9 of 16^th June, 2016 refers).

 

Positive progress from Phase 1 of the transformation was highlighted and then details of the new model were outlined, including recognising the differing needs of young adults aged 18 compared with for example adults aged 70+.

 

Discussion ensued on the report with the following issues raised/highlighted:-

 

-          How local would the services feel to the Service user?  Would they be accessing the services at their GP or would there be 2 central buildings, north and south?

The In-Patient Services would stay where they were i.e. Woodlands (for Older Persons Services) and Swallownest Court (for Adult Services).  The organisation was looking at what resources building wise it had in the north as it was recognised that was a real area for requirement.  A number of patients had home visits and they would continue.  Staff did have agile working but staff bases were required and whatever community assets there were would be used in order to link in with making the services as accessible as possible

 

-          Have you considered whether whoever did the ‘signposting’ actually made the first contact on behalf of the client?

Work was taking place with a couple of Council Officers who had done a huge amount of work looking at what agencies were out there, what was offered, what had changed etc. and were putting together a directory.  The mapping of all the assets would also include the way the services were accessed some of which were by the client only.  However, all staff were being encouraged to make the first point of contact dependent upon the patient’s wishes.  It was also about signposting more accurately to the appropriate service, what they were being signposted for and how it would happen

 

-          Would there be time frameworks for the transformational change especially for CAMHS?

There was an absolute commitment to complete the transformation with the Trust stating their intention of October for having all the management structure in place which was where most of the savings were coming from.  Some of the Service users would not necessarily notice a difference to their service as they would have the same care coordinator; the difference would be for the newer patients who would go through a different progress and process.  There was a lot of work taking place around the transition from CAMHS to Adult Services.  It was monitored by the CCG and was with regard to identifying those people earlier than they were currently

 

-          Preventing inpatient stays.  Was there sufficient funding to employ additional community nurses and therapists if the service increased?   If successful, the budget would move to the community.  Was there enough trained staff to cover the needs of the staff in the community?

The budget was what it was and, together with the resources, had to be managed accordingly.  At the moment inpatient beds were full and that was not envisaged to change but it was the length of stay that had to be managed.   There was a huge demand for services in the community, far more than currently could be managed and sometimes it was about helping people to access the right services and working with primary care and other organisations

 

The Service regularly met with the Police, the Vulnerable Persons Unit etc.  The organisation was looking at the skill mix and what was required as it moved forward; it was not necessarily about qualified staff but support workers as well and linked into how Direct Payments were used and other community assets

 

-          Are we working with GPs with regard to depression and those patients that required counselling?  The GP was usually the first point of contact if a person had never had a mental health issue

As part of the programme the Service was working with Primary Care both in Dementia and the Improving access to Psychological therapies (IAPT) Service to support GPs.  Additional funding had been invested in developing a Dementia Pathway so that GPs would start to lead more in the diagnosis and support of people within their practice.  There was also a Dementia Care Resilience Service which supported carers of those with Dementia   

 

There had been some challenges for IAPT in the past year relating to waiting times. There was a whole set of national targets that the Service had relating to decreasing people’s wait for IAPT services.  One was that 75% of people have to receive an appointment within 6 weeks.  A lot of work had taken place with the IAPT Service and there was the possibility of additional investment. Work had taken place with the national team and seen some significant decreases in the waiting times.  The IAPT service was based in GP practices so there was a strong link and the organisation was currently reviewing the service as to further improvements. There was a lot of work around depression and anxiety and that aspect of the Service 

 

-          With regard to the Service configuration and framework how would you monitor the anticipated benefits to make sure that you achieved the measures laid out

There was a performance team that monitored measures such as referral rates, complaints and compliments, PALS etc. and were reported on a quarterly basis

 

-          Had Learning Disabilities been included within Phase 1?

The document submitted related to Adult Services (those 18+ years).  A whole host of additional transformational processes were being undertaken at the moment and Learning Disabilities were undergoing transformation and was a separate programme of work.  Over the past couple of years service changes had led to an enhanced Community Service which had reduced the need for inpatient and ATU beds.  The Services was also, as part of a national requirement, working with colleagues from across Doncaster, Sheffield and North Lincs CCGs and local authorities as part of the Transforming Care Partnership which was a programme of work around improving services for people with learning disabilities and linked with the Winterbourne.   It was acknowledged that the CAMHS, Learning Disability and Adult transformations needed to be aligned due to the crossover between the Learning Disability and Mental Health Services and about how to make sure those transitions were smooth 

 

Some work had been taken place, the Green Light Agenda, where Adult Mental Health Services worked closely with Learning Disability Services.  They met regularly in terms of strategic development and to identify service users that potentially would drop between the gap between Services.  They also looked at what reasonable adjustments Adult Services could make and what support from Learning Disability Services may be needed from a mental health point of view.  There was a lot of support from the Learning Disability Services and they would support RDaSH in the community.  Transitions between the 2 Services was much better than it had been

 

-          How were the discussions progressing with regard to the Care Co-ordination Centre becoming the single point of access?

Discussions were continuing including looking at the amount of work that came into the Services through their points of contact and what would be required in terms of staff training, costings and algotherims.  It was not close to happening yet but the conversations were progressing

 

-          How did you envisage a new Rotherham hub including Adult Social Care?

From a Mental Health perspective it was about helping people navigate the services as easily as possible.  There were conversations about accessing anything from anywhere via one point of contact. In terms of the actual staff on the ground there was a real will to work towards that.  It was about making the journey as smooth as possible for the people that wanted it

 

-          How did that link with the plans that were in place regarding organisational development strategy and ensuring skills because the whole package around the hub would be specialist skills and how they fitted along the pathway of care

The representative could only really comment on the transformation that was being worked on; the other was an aspirational idea that needed a lot of work

 

-          Page 36 of the document made reference to the challenges and risks for 2017/18 including staff reviews.  To what degree had this been planned for now before the new model was implemented to try and avoid further major change?

The plan was for several years of savings and the changes in the service regarding the client group was equally a plan for the future.  It was a long term plan

 

-          Did the plan include early diagnosis of various conditions or potential conditions such as Autism and would this decrease the waiting time?  Were there any facilities planned for Rotherham?

With regard to diagnosis of Autism in adults, there had been training within the Disability Teams so there was now the ability within Learning Disability to carry out a diagnosis.  The amount of activity for adults had also been increased in Sheffield.  This was the normal pathway as it was a specialist service and there was not the specialism within Rotherham.  The waiting times were reducing but it was an area that required further work and discussions were taking place with the Local Authority.  Discussions were also to commence around an Autism Strategy which would really start to look at what issues there were and how we might start to work on those issues

 

-          Do we buy diagnostic tools for Autism in the Rotherham area?  Was it all in Sheffield?

It was still in Sheffield but 4 Rotherham members of staff had recently been trained in the ADOS techniques of diagnostic.  Staff had now been asked to cost the purchase of the tool.  It would feed into the Autism Strategy

 

-          How would you build safeguards into the initial screening and prioritisation of staff at the point of contact to ensure patient safety and appropriate next steps?

As part of a generic assessment, there were questions around Safeguarding and all the staff undertook mandatory training.  There was supervision around Safeguarding so staff could access Lead Nurses and linked into the Local Authority.  On top of the full Needs Assessment, each patient had a risk assessment which included Safeguarding

 

-          When doing the appraisals there would be a percentage of people that were misdiagnosed and they could be channelled into a certain channel which was the wrong place.  Would you guess at a percentage of misdiagnosis? 

The diagnostics were carried out by psychiatrists and not nurses.  Unless done by a diagnostic person such as a psychologist, generally mental health diagnoses were delivered and determined by a psychiatrist.  There were staff trained in Mental Health and Mental ill health and a recognition of the symptoms of that.  In the last 10/15 years staff had been trained in more psychological approaches so it moved away from purely a medical model which was about treating symptoms with medication which did not always work because they were often based in social/historical/trauma issues.  As the awareness of psychology and the psychological application to mental ill health was wider, more staff were aware and this informed treatment.  Cognitive Behavioural therapists had a 2 year degree course to complete.  The staff that were doing CBT informed therapy undertook a 5 day training course supervised by a CBT therapist to do anything more complex   

 

There was a way of working with an individual called “developing a formulation”.  This was about understanding all the components of a person and that was psychologically informed but also informed by everyone around them such as the patient themselves and the carer.  Staff were being trained to use that more and about mapping out the whole story

 

Diagnostics came from psychiatrists and they did not always get it right because a person’s personality develops over time and how a person presented may not be the same when they were young as when they were older.  Some symptoms could be masked by other presentations e.g. quite depressed but in fact have Dementia

 

-          Cognitive Psychology was a new approach to appraising people.  Some staff were being trained in 5 days  because of the shortage of psychiatrists/psychologists and the pressure on them 

The Service did train staff up to deliver Cognitive Behavioural Therapy (CBT) and had also trained psychologists in the Service.  It was about developing the skill base of the staff and would look to develop the skill set because psychologists were very expensive and there were very few of them 

 

-          How was the ease of access to clinicians for advice for the administrative staff at the initial single point of access?

This worked now and would carry on working in the CCG and would be the same for Older People Mental Health Services.  The administrative staff tended to take the basic information and then passed it to a clinician to make a decision as to what happened next

 

The Chairman thanked the Alison, Kerri and Kate for their attendance.

 

Resolved:-  (1)  That the report be noted.

 

(2)  That any comments to inform the final model would be submitted to the RDaSH Trust Board for approval.

 

(3)  That the phased implementation by April, 2017 be noted.

 

(4)  That a report be submitted in September, 2017.